Customer Service Administrative Assistant
Resume:
Monica Marquez
Austin TX **745
About Me: I am a dedicated employee of FirstCare HealthPlan. I am acquainted with Microsoft Office, both 2000 and 2007 and most of the features included such as Microsoft Excel, Spreadsheet, Access & SharePoint. I have 5 years’ experience in Customer Service along with knowledge of Medicaid and Medicare. I also have Knowledge and experience with Health Insurance including Provider Contracts, Enrollment, and Provider Eligibility. I type at least 45 wpm, and am very focused and efficient. I have very good communication skills allowing me to perform my job to the best of my ability.
Education:
• Crockett High School - 2005
High School Diploma
Employment History:
FirstCare HealthPlan, Inc.
Supervisor: Stephanie Johnson
July 2012 – Present
Provider Contract Administrative Assistant
The Provider Contract Administrative Assistant
Primary responsibilities would consist of:
- Reconcile Provider’s Contracts such as Individual Agreements, Group Agreements, Amendments, Addendums and Exhibits
- Scan over 12,500 Provider Contracts
- Index/Bookmark Provider Contracts
- Contract Inventory on SharePoint
- Contract Audit after project is completed
- Filing Provider Contracts
- Label / Alphabetize Provider Contracts
ACS State Healthcare, LLC
Texas Medicaid and Healthcare Partnership, Medical Affairs
Supervisor: Janet Miles
July 2011- Present
Prior Authorizations Specialist
Dental/CCP Prior Authorizations Specialist - Examination and processing of prior authorization requests; Reviews appropriate assessment forms according to established criteria and protocols compliant with Texas Health and Human Services Commission. Maintains appropriate documentation on all requests and enters the documentation in the appropriate computer application.
- Review and process Dental and Orthodontic prior authorization requests accurately and efficiently.
- Research and report potential MFADS (Medicaid Fraud and Abuse) cases to the Dental Medical Director, Dental Supervisor and Management Team.
- call center environment and answers questions on medical issues.
- Updates and fills out patient medical records.
- Codes and fills out insurance forms.
- Handles correspondence, billing and bookkeeping.
- Explains treatment procedures to patients.
- Helps prepare prescribed medication for patients, such as counting tablets and labeling bottles.
- Establishes and maintains patient profiles, prepares insurance claim forms, and stocks and takes inventory of prescription and over-the-counter medications.
Progressive Insurance
Supervisor: Liddy Dorisman
Sept 2010- July 2011
Central Claims Representative
The Central Claims Representative - handles losses involving single vehicles or limited number of features via in-bound and out-bound calls. Coordinates the resolution of physical damage, rental and other associated coverage issues.
- Takes recorded statements from insureds, claimants, agents, witnesses, police officers, passengers and other parties as needed.
- Completes investigative research to verify coverage, makes coverage decisions, and resolves basic coverage issues.
- Interprets policy and state laws in order to make accurate coverage decisions.
- Makes recommendations on claims with potential grounds for coverage denial.
- Communicates decisions regarding coverage and draft payment amounts.
- Ensures claims are resolved to Progressive Claim's standards.
- Ensures that all damage is consistent with the report of the accident.
- May research information needed to resolve the claims, including internet searches.
Aditya Birla Minacs Austin, TX
Supervisor: Patricia Burcham
April 27 2007 – Sept 2010
Product Allegation Department
Product Allegation Resolution Specialist – I determine whether General Motors should assist or deny customers any assistance based the validity of the claim, as well as delivering the resolution in a manner that the customer is calm and satisfied that General Motors took the time and expense to investigate their concern and understands that the resolution offered is the very best that General Motors has to offer. Also have a close working relationship with Service, Sales and Area Service Managers. I am also responsible for receiving inbound and outbound calls to and from customers. I provide the best customer service to every customer. I am required to meet all goals and metrics required every month. I am required to assist customer's with thier concern with thier general motors vehicle, entering the customer's information into the system used.
Tier 2 Agent With Customer Assistance - Provide upper level support for 150 State Dealers in six different states, which involved engaging service managers and General Motors field representatives to resolve customer’s issues.
Customer Service Agent – I assisted customers with problems ranging from simple questions about how to check the vehicle’s tire pressure to problems with dealerships that were causing customers to be unable to have their vehicles properly maintained. I also convinced dealerships throughout the county of the return on investment to spend a little money up front to gain and retain a loyal customer at their dealership with money provided by General Motors to use on such gestures of Goodwill.
Dillards Department Store Austin TX
Supervisor: Patricia Wilbourn
July 2006 – January 2007
Sales Associate/ Customer Service Representative
I worked at Dillards inside Barton Creek Square Mall. I was responsible for providing customer service with the best, most professional service possible in order to meet sales goals. This included, but was not limited to, helping customers with finding the correct size clothing they needed along with style the customer requested in a way that customers were pleased to take the advice, as well as sorting, organizing and preparing incoming stock that arrived. Along with keep the dept store clean and presentable for customers when customers arrived. I was also responsible for making sure merchandise was in the proper place, and maintaining a healthy and positive work environment. I also checked customers out with the merchandise the customer choose to purchase.
Sears Call Center Round Rock, TX
Supervisor: Lyyn Brown
March 2006- July 2006
Customer Service Representative
I was responsible for taking inbound and outbound calls to our Sears customer, answering questions on when customer’s merchandise would arrive along with time and date. I provided great customer service to the customer I spoke with each and everyday. I was also responsible for scheduling appointment with customers that had problems with their merchandise for a technician to arrive at their homes to assist the customers, I answered simple questions on assisting customer’s on how to use their merchandise and step by step on how to fix concerns over the phone without having to send a technician to the customers home. I was trained to learn about all the brands Sears provided such as Kenmore, GE, Whirlpool ect. In order to answer customers questions over the phone. I am required to adhere to my schedule and be on time with breaks, lunches. Meet Sears metrics on sale goals that was required every month.
Ace Cash Express Austin, TX
Supervisor: Rafael Lopez
August 2005 – April 2006
Customer Service Representative/ Loan Representative
I worked between 11 to 12 hour shifts alone to insure high security with handling over 20k alone. I was responsible for greeting customers as they arrived. I was responsible for cashing personal to company checks, processing deposits and withdraw. I processed customer’s applications on small and large loans that the customer requested making sure all documents that were needed from the customer were correct and accurate in order to process the loan request, taking payments and processing the payment to the customers loan. Along with making outbound calls to customers to remind customers on when their payment is due and if payment is past due. I maintained the store such as cleaning and organizing the store and made sure company slips such as applications and deposit slips were available to the customers when needed. I was responsible for controlling money and making sure the store had the correct amount throughout the day, along with meeting the stores goals everyday. I worked in different south Austin store locations when help was needed.
Baskin Robins Ice Cream Austin, TX
Supervisor: Ashish Patel
August 2003 – July 2005
Shift Leader
Provide the best customer service to family and friends, Serve ice cream, shakes, malts to customers. Prep Ice Cream in a fast pace environment. Once inventory arrived I was responsible for keeping track of what arrived and what Baskin Robbins needed in stock to last, sorting the ice cream, organizing and preparing incoming stock, keeping the store clean and presentable by cleaning both before the store opened each day and after the store closed. I managed shift schedules for the employees, controlled pay checks and making sure hours were accurate. I was also responsible for the store meeting the sales goals each and everyday. Along with handling money, making deposits and withdrawing money as needed each day.
References:
Ashish Patel
Miguel Aguero – *************@********.***
Patricia Burcham – ****************@********.***
Home:512-***-**** Cell:905-4378 Work: 512-***-****
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